Raúl Martínez-Fernández, Steffen Paschen, Marta del Álamo, Rafael Rodríguez-Rojas, Jose A Pineda-Pardo, Javier Blesa, Michael G Kaplitt, Günther Deuschl, José A Obeso
{"title":"Focused ultrasound therapy for movement disorders","authors":"Raúl Martínez-Fernández, Steffen Paschen, Marta del Álamo, Rafael Rodríguez-Rojas, Jose A Pineda-Pardo, Javier Blesa, Michael G Kaplitt, Günther Deuschl, José A Obeso","doi":"10.1016/s1474-4422(25)00210-8","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00210-8","url":null,"abstract":"Functional neurosurgery, such as deep brain stimulation, is an established therapeutic option for many patients with movement disorders. MR-guided focused ultrasound has emerged as an incisionless and minimally invasive neurofunctional treatment. This new approach is based on the delivery of high-intensity ultrasound energy to produce therapeutic thermoablation. Several randomised controlled trials have shown safety and symptomatic efficacy of focused ultrasound ablation, particularly to treat patients with essential tremor or Parkinson's disease. The use of focused ultrasound therapy is expanding to many centres worldwide, and its application for other indications—such as tremor of other origin and dystonia—has also been preliminarily investigated. MR-guided focused ultrasound has been explored in the modality of low-intensity ultrasound, which allows mechanical effects on brain tissue, primarily transient blood–brain barrier opening and neuromodulation, both of which could offer a wide array of experimental and clinical possibilities. Therefore, MR-guided focused ultrasound might have an important role in the future treatment of patients with movement disorders and neurodegenerative diseases.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sue Peters, Stanley H Hung, Mark T Bayley, Krista L Best, Louise A Connell, Sarah J Donkers, Sean P Dukelow, Victor E Ezeugwu, Marie-Hélène Milot, Brodie M Sakakibara, Lisa Sheehy, Hubert Wong, Yuwei Yang, Jennifer Yao, Janice J Eng
{"title":"Safety and effectiveness of the Walk ‘n Watch structured, progressive exercise protocol delivered by physical therapists for inpatient stroke rehabilitation in Canada: a phase 3, multisite, pragmatic, stepped-wedge, cluster-randomised controlled trial","authors":"Sue Peters, Stanley H Hung, Mark T Bayley, Krista L Best, Louise A Connell, Sarah J Donkers, Sean P Dukelow, Victor E Ezeugwu, Marie-Hélène Milot, Brodie M Sakakibara, Lisa Sheehy, Hubert Wong, Yuwei Yang, Jennifer Yao, Janice J Eng","doi":"10.1016/s1474-4422(25)00201-7","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00201-7","url":null,"abstract":"<h3>Background</h3>Although clinical guidelines support high repetitions of walking after stroke, practice is slow to change. We undertook an implementation trial to enable entire stroke units to use the Walk ‘n Watch structured, progressive exercise protocol. Our objective was to evaluate the effectiveness of the Walk ‘n Watch implementation package on patient outcomes after 4 weeks in an inpatient stroke rehabilitation setting.<h3>Methods</h3>This pragmatic phase 3, stepped-wedge, cluster-randomised controlled trial took place in 12 sites (inpatient stroke rehabilitation units) across seven Canadian provinces. Each site was randomly allocated (1:1:1:1) to one of four transition sequences with three sites in each sequence. Sites changed practice from usual care to Walk ‘n Watch at different times according to their allocation. All front-line physical therapists were trained to deliver the Walk ‘n Watch protocol. Walk ‘n Watch required completion of a minimum of 30 min of walking-related activities per session, which progressively increased in intensity based on heart rate and step count monitors. Progressions were prescribed on the basis of a screening 6-minute walk test (6MWT) done by the front-line physical therapist as part of the protocol. The primary endpoint was walking endurance (6MWT) at 4 weeks after randomisation. Masked assessors completed evaluations at baseline and 4 weeks later. The primary analysis used a linear mixed-effects model adjusted for unit size, stratum, calendar time, age, sex, and baseline 6MWT. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT04238260</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is complete.<h3>Findings</h3>Between June 4, 2021, and March 1, 2024, we enrolled 12 sites with 314 participants, of whom eight were deemed ineligible after enrolment and 306 were included in the primary analysis (162 in the usual care group, 144 in the Walk ‘n Watch group). Participants had a mean age of 68 years (SD 13), a mean time since stroke of 29 days (17), and a baseline 6MWT of 152 m (106). 188 (61%) were male and 118 (39%) were female. The mean 6MWT in the usual care group was 137·1 m (100·9) at baseline and 223·6 m (130·4) after 4 weeks. The mean 6MWT in the Walk ‘n Watch group was 163·6 m (112·7) at baseline and 297·2 m (133·2) after 4 weeks. The 6MWT improvement was 43·6 m (95% CI 12·7–76·1) greater in the Walk ‘n Watch group than in the usual care group. No serious adverse events occurred during a Walk ‘n Watch session. Nine serious adverse events were reported and required admission to acute care (four were ","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yan Li, Jorge J Llibre-Guerra, Charlene Supnet, Alireza Atri, Eric M McDade, David B Clifford, Randall J Bateman
{"title":"Interpreting the evidence on gantenerumab for dominantly inherited Alzheimer's disease – Authors' reply","authors":"Yan Li, Jorge J Llibre-Guerra, Charlene Supnet, Alireza Atri, Eric M McDade, David B Clifford, Randall J Bateman","doi":"10.1016/s1474-4422(25)00239-x","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00239-x","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Accelerating the path towards a cure for Parkinson's disease","authors":"","doi":"10.1016/s1474-4422(25)00243-1","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00243-1","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julian Agin-Liebes, Alexandra Lodge, Hasini Reddy, Elena Vacchi, John Usseglio, Lawrence S Honig, Giorgia Melli, James M Noble, Serge Przedborski
{"title":"α-synuclein biomarker assays: bridging research and patient care","authors":"Julian Agin-Liebes, Alexandra Lodge, Hasini Reddy, Elena Vacchi, John Usseglio, Lawrence S Honig, Giorgia Melli, James M Noble, Serge Przedborski","doi":"10.1016/s1474-4422(25)00194-2","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00194-2","url":null,"abstract":"The discovery that α-synuclein can be detected in peripheral tissues of patients with Parkinson's disease and other synucleinopathies spurred the development of biomarker assays, including the α-synuclein seed amplification assay for CSF and immunofluorescence detection of dermal phosphorylated-α-synuclein. These tools aim to identify pathological α-synuclein changes, even at the early stages of disease, with the goal of eventually enabling differentiation of Parkinson's disease from other neurodegenerative disorders, including tauopathies. α-synuclein biomarkers add a biological component to the traditional clinical diagnosis of Parkinson's disease, with potential for development of complementary clinical and pathobiological frameworks for Parkinson's disease and related movement disorders. However, use of existing α-synuclein biomarkers is restricted to research settings due to variable sensitivity and specificity, restricted availability of neuropathological data for validation, and scarcity of longitudinal studies. Addressing these limitations is crucial for advancing clinical and biological disease definitions, which will be essential for the development of disease-modifying therapies.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to Lancet Neurol 2025; 24: 316–30","authors":"","doi":"10.1016/s1474-4422(25)00248-0","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00248-0","url":null,"abstract":"<em>Bateman RJ, Li Y, McDade EM et al. Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial.</em> Lancet Neurol <em>2025;</em> 24: <em>316–30</em>—In the Declaration of interests section of this Article, statements have been corrected for Alireza Atri. A grant number has been corrected, and the appendix has been resupplied. These corrections have been made to the online version as of July 9, 2025.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marte Helene Bjørk, Cristine Cukiert, Bruna Nucera, Rebecca L Bromley
{"title":"Management of reproductive risks in people with epilepsy","authors":"Marte Helene Bjørk, Cristine Cukiert, Bruna Nucera, Rebecca L Bromley","doi":"10.1016/s1474-4422(25)00130-9","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00130-9","url":null,"abstract":"Epilepsy is a common neurological condition worldwide, presenting unique management challenges for those affected during reproductive age. The effectiveness of contraceptives can be modified by antiseizure medication treatments and pregnancy can alter the pharmacokinetics of antiseizure medications. Furthermore, although treatment with some antiseizure medications convey lifelong risks to offspring, inadequately controlled epilepsy can lead to injury or, in rare cases, death of the mother. In this complex set of circumstances, safe and effective antiseizure medication treatment, evidence-based decision making regarding contraceptive selections, and clear counselling and risk minimisation are imperative. Although risk–benefit decision making has become standard clinical practice for the management of women with epilepsy of childbearing age, reproductive treatment considerations could also be relevant for men. Most young adults with epilepsy live in low-income and middle-income countries, where access to contraceptives, antiseizure medications with adequate safety profiles, and reproductive care and counselling can be scarce. Strategies to optimise care for people with epilepsy in all stages of their reproductive journey must be tailored for resource-limited settings to improve parent–child health worldwide.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
